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Eckers F, Hochreiter B, Forsyth S, Ek ET. Proximal humerus reconstruction in reverse total shoulder arthroplasty with proximal humeral bone loss using a lower trapezius tendon transfer with Achilles tendon-bone allograft: surgical technique and report of 2 cases. JSES Int 2024; 8:508-514. [PMID: 38707582 PMCID: PMC11064716 DOI: 10.1016/j.jseint.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Affiliation(s)
- Franziska Eckers
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Sarah Forsyth
- Melbourne Orthopaedic Group, Melbourne, Australia
- Melbourne Shoulder Group, Melbourne, Australia
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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Dannaway J, Sharma G, Raniga S, Graham P, Bokor D. Is preoperative elevated glycated hemoglobin (HbA1c) a risk factor for postoperative shoulder stiffness after posterior-superior rotator cuff repair? JSES Int 2024; 8:47-52. [PMID: 38312295 PMCID: PMC10837722 DOI: 10.1016/j.jseint.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Postoperative shoulder stiffness (POSS) affects a large number of patients undergoing rotator cuff repair (RCR). Diabetes may increase the risk of POSS. Preoperative glycated hemoglobin (HbA1c) is a convenient measure of glucose control in this group. The aim of the present study was to determine a relationship between preoperative HbA1c and POSS in patients undergoing postero-superior RCR. Methods Two hundred fifty patients with full-thickness postero-superior rotator cuffs who underwent RCR were followed for 6 months. Pre- and post-operative external rotation with arm by the side at 3 and 6 months were measured. Patient demographics, tear characteristics, preoperative HbA1c level, and surgical details were recorded. Patients with subscapularis tears, concomitant instability, partial thickness tears, arthritis, and irreparable rotator cuff tears were excluded. Univariate and multivariate logistic regression were used to determine the association between patient characteristics and POSS at 6 months. Results At the end of 6 months, 16% (41/250) of patients had POSS. Multivariate analysis demonstrated an elevated preoperative HbA1c level was a statistically significant predictor of POSS at 6 months (odds ratio 7.04, P < .01) after posterior superior RCR. Lower preoperative external rotation (P = .02) and female sex (P < .01) were also risk factors associated with POSS. Age, hand dominance, worker's compensation claim status, etiology, and size of the tear, surgical technique, and additional treatments were not statistically significant predictors. Conclusion Elevated preoperative HbA1c level is associated with POSS after RCR. Measuring HbA1c preoperatively may assist clinicians to identify patients at risk of POSS. HbA1c is a modifiable parameter that could then be optimized preoperatively in order to improve outcomes.
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Affiliation(s)
- Jasan Dannaway
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gaurav Sharma
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sumit Raniga
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Petra Graham
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Desmond Bokor
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
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Kawabuchi K, Nakamura M. Changes in blood flow in the dorsal scapular artery and relationship to shoulder joint function in rotator cuff tears. JSES Int 2023; 7:2356-2360. [PMID: 37969537 PMCID: PMC10638572 DOI: 10.1016/j.jseint.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background One of the pain-related factors in rotator cuff tears (RCTs) is abnormal scapular motion, which is thought to be related to the levator scapulae muscle activation. Additionally, attention has recently focused on the peak systolic velocity (PSV) as one of the causes of pain, but blood flow outside of the vessels supplying the rotator cuff has not been clarified. This study aimed to determine the difference in PSV in the dorsal scapular artery (DSA), which is the vessel that supplies the levator scapulae muscles, and the association between PSV and pain and shoulder function in patients with RCTs between the tear and nontear sides. Methods This study included 31 patients with RCTs with tear and nontear sides. Magnetic resonance imaging and radiographic examinations included Cofield classification, Goutallier classification, thickening of the coracohumeral ligament, and measurement of the acromiohumeral interval. Clinical evaluation included an automatic range of motion (ROM) for flexion, abduction, and external rotation (ER), a visual analog scale, and the Shoulder36. PSV was evaluated using ultrasound pulsed Doppler mode to assess PSV of DSA. The PSV of DSA on the first rib was drawn in the medial aspect of the suprascapular angle in the long axis, and the maximum PSV waveform was measured three times. The average value was used for further analysis. Results The PSV in the DSA was significantly higher (P = .04, 95% confidence interval: 0.2-7.6) on the tear (22.6 ± 7.4 cm/s) than the nontear sides (18.9 ± 6.9 cm/s). In addition, a significant negative correlation (r = -0.46, P = .0087) was found between PSV in DSA and ER on the tear side. Conclusion This study revealed a significantly increased PSV in the DSA on the tear side in RCTs and negatively correlated with ER ROM. The results suggest that increased PSV in the DSA may contribute to ER ROM limitation in the glenohumeral joint.
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Affiliation(s)
- Keita Kawabuchi
- Rehabilitation Room, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Science, Nishi Kyushu University Ozaki, Kanzaki, Saga, Japan
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Mukartihal R, Bhat V, Das R, Chandan S, Patil SS, Rathnakar V, Gurava Reddy A, Annapareddy A. Relationship between femoral component placement and patient-specific anatomical rotational landmarks in robotic arm assisted total knee Arthroplasty- a multicentric study. J Orthop 2023; 45:87-90. [PMID: 37869414 PMCID: PMC10585283 DOI: 10.1016/j.jor.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Osteoarthritis of the knee is a common problem in the elderly, leading to severe morbidity. Total Knee Arthroplasty (TKA) is a widely validated surgery to provide a remarkable extent of knee function and simultaneously alleviates pain for knee osteoarthritis (OA). It is clearly understood that precision of the rotational alignment and accuracy of the technique in the placement of the femoral component is a prerequisite for excellent and successful outcomes of TKA. Advanced technology has now allowed surgeons to understand patient-specific variabilities in anatomical reference landmarks and the relationship of component positioning in relation to the reference landmarks to achieve accurate gap balancing with minimal soft tissue release.14 Robotic Arm Assisted-Total Knee Arthroplasty (RAA-TKA) is a semi-automated system that enables us in replicating the same. Using this technology, the bony resections, component positions, probable component sizing and gap balancing can be tentatively planned preoperatively with CT Scan Analysis and executed intraoperatively. Hence this study was undertaken to estimate the relationship between femoral component placement to normal rotational landmarks such as the Posterior Condylar Axis (PCA) and to quantitatively evaluate coronal and sagittal plane correction obtained. Also, we aimed to use the data to detect any anatomical variations in the study population and evaluate the accuracy of predicted component sizing, including gender-based evaluation. Materials and methods A Prospective Observational Study of 1073 knees of patients of either sex above 50 years of age with Kellgren Lawrence Grade 4 Osteoarthritis of the knee which were confirmed with X-Ray undergoing RAA-TKA using MAKO Robotic System using Stryker Triathlon (Cruciate Substituting) CS Knee was conducted during the period between 2022 and 2023 in two South Indian hospitals specializing in joint replacement surgeries. Results We found a statistically significant difference between the native Posterior Condylar Axis (PCA) (4.82 ± 2.15°) and final femoral component external rotation (3.24 ± 1.29°) with a p-value of <0.001 at 95% confidence interval. The accuracy of component size prediction was 99.8%. Also, analysis in our study has shown the most common implant sizes to be 4 in males and 2 in females. We also found no statistically significant difference based on age, size, laterality, or primary varus deformity. Conclusions RAA-TKA provides patient-specific alignment/restricted kinematic alignment which might further enhance the outcome for the patient. Reliable deformity correction in coronal and sagittal planes can be achieved. Accurate flexion and extension gap balancing can be done through component placement and with minimal soft tissue dissection. Irrespective of all the advantages noted in RAA-TKA, further follow-up and long-term outcome studies are required to properly gauge and analyze this new technology.
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Affiliation(s)
| | | | | | - S. Chandan
- SPARSH Group of Hospitals, Bangalore, India
| | | | - V. Rathnakar
- Department of Orthopaedics, Sunshine Hospitals, Hyderabad, India
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Druel T, Buffard M, Nové-Josserand L, Walch A. Role of middle glenohumeral ligament in external shoulder rotation. JSES Int 2023; 7:331-335. [PMID: 36911782 PMCID: PMC9998722 DOI: 10.1016/j.jseint.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The middle glenohumeral ligament (MGHL) is one of the three ligaments that stabilize the anterior capsule of the shoulder. Recent work suggests that it inserts distally into the deep layer of the subscapularis tendon. The role of the MGHL remains debated. The hypothesis of this study was that the MGHL plays a significant functional role in limiting external rotation of the shoulder while allowing a wide range of motion through its distal insertion into the subscapularis rather than directly onto the humerus. Methods In a cadaveric study performed on 20 shoulders (10 subjects), the MGHL and the other anterior structures of the shoulder were successively cut according to a standardized protocol. At each stage, the external rotation range of the shoulder was measured with the arm at the side (ER 1) and in 90° abduction (ER 2) using a goniometer. After dissection, the structure of the MGHL and its distal insertion were analyzed. Results Cutting the MGHL led to significant increases in ER 1 but not in ER 2. Shoulder range of motion in ER 1 increased on average by 15 ± 5° (P < .001) after cutting the MGHL and by 21 ± 11° (P < .001) after subscapularis peel. The range of motion in ER 2 increased by 3 ± 4° (P = .048) after cutting the MGHL, by 4 ± 6° (P = .02) after subscapularis peel and by 25 ± 8° (P < .001) after cutting the inferior glenohumeral ligament. The MGHL was present in all dissected shoulders. It was leaf-like in 12 cases, cord-like in 6 cases and had a vestigial appearance in 2 cases. The distal insertion was in all cases in the deep layer of the subscapularis in a thickening of the anterior capsule in the superior part of the muscle, except for two cases in which the tendinous part of the subscapularis was also involved. Conclusion The MGHL limited shoulder external rotation by a similar amount as the subscapularis muscle. Further studies are required to understand the clinical relevance of these findings, notably for the treatment of shoulder stiffness.
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Affiliation(s)
- Thibault Druel
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France.,Laboratoire d'Anatomie Médico-Chirurgicale, Faculté de Médecine Lyon-Est, Lyon, France
| | - Marius Buffard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France.,Laboratoire d'Anatomie Médico-Chirurgicale, Faculté de Médecine Lyon-Est, Lyon, France
| | | | - Arnaud Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France.,Laboratoire d'Anatomie Médico-Chirurgicale, Faculté de Médecine Lyon-Est, Lyon, France
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López-Vidriero Tejedor R, Laver L, López-Vidriero Tejedor E. Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome. Knee Surg Sports Traumatol Arthrosc 2023; 31:2152-2159. [PMID: 36637477 DOI: 10.1007/s00167-023-07310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To analyze the shoulder alterations of professional tennis players during the competition season and to compare the differences between their dominant vs. non-dominant shoulders, as well as gender and age differences. METHODS Two-hundred and seventy shoulders of (78 men and 57 women) professional active tennis players were assessed during 3 ATP and WTA tournaments. MAIN VARIABLES STUDIED long head of biceps (LHB) tenderness and synovitis; glenohumeral internal rotation deficit (GIRD), total range of motion (TRM), external rotation (ER) and scapular dyskinesis (DK). Secondary variables: shoulder dominance, gender, age, training hours, ranking, type of backhand. LHB tenderness and synovitis were assessed by clinical and ultrasound examination, TRM with goniometer and DK by dynamic observation. RESULTS LHB tenderness of the dominant shoulder was present in 35% of all players, being more prevalent in women (47.4%) than men (26.9%) p = 0.023. LHB synovitis of the dominant shoulder was present in 20.2% of all players without difference between genders (n.s). High prevalence of GIRD was found in both dominant (87.4%) and non-dominant (56.3%) shoulders, being more prevalent in the dominant shoulder p = 0.00005. TRM was decreased in both dominant (144.5° ± 20.2°) and non-dominant shoulders (161.2° ± 18.9°) p = 0.00005. ER was normal in dominant (93.8° + /9.3°) and non-dominant shoulders (93.4° + /8.4°) (n.s). DK was present in 57.7% of dominant and 45.9% of non-dominant shoulders (n.s). The combination of LHB alterations, GIRD and DK in the dominant shoulder was present in 13.3% of the participants. There were no significant differences between younger (< 22 years) vs older players (≥ 22 years). CONCLUSION Professional tennis players actively playing suffer a high prevalence of LHB inflammation, GIRD, scapular dyskinesis and decreased TRM in their dominant and non-dominant shoulders. The LHB is a significant cause for anterior shoulder pain in this population. Women suffer more LHB tenderness than men. Young players are as affected as older players. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Rosa López-Vidriero Tejedor
- ISMEC (International Sports Medicine Clinic), Seville, Spain. .,Hospital Universitario Infanta Elena, Madrid, Spain. .,Mutua Madrid Open 1000 ATP/WTA Tennis Masters, Madrid, Spain.
| | - Lior Laver
- Department of Orthopaedics and Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,AtrhroSport Clinic, Tel-Aviv, Israel
| | - Emilio López-Vidriero Tejedor
- ISMEC (International Sports Medicine Clinic), Seville, Spain.,Hospital Universitario Infanta Elena, Madrid, Spain.,Mutua Madrid Open 1000 ATP/WTA Tennis Masters, Madrid, Spain.,Andalusian Tennis Federation, Seville, Spain.,Orthopedic Department, Hospital Universitario Virgen Macarena, Seville, Spain
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Jang SJ, Jones C, Shanaghan K, Mayman DJ, Della Valle AG, Sculco PK. The Impact of Varying Femoral Head Length on Hip External Rotation During Posterior-approach Total Hip Arthroplasty. Arthroplast Today 2023; 19:101072. [PMID: 36624748 DOI: 10.1016/j.artd.2022.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 01/05/2023] Open
Abstract
Background Prior investigations of total hip arthroplasty (THA) have studied the effects of prosthetic femoral head size and stem offset on hip range of motion (ROM), impingement risk, and overall hip stability to optimize the return to activities of daily living. However, the relationship between femoral head length and hip ROM, specifically external rotation (ER), has not been evaluated. The aim of our study was to intraoperatively assess how femoral head length affects hip ROM during a posterior approach THA. Methods Thirty-two patients undergoing a primary elective THA through a posterior approach were prospectively included. After final femoral stem insertion, femoral head trials were performed using the targeted head length, followed by the shorter (-3.0 to -3.5 mm) and longer (+3.0 to +4.0 mm) head length configurations. At each length, hip ER was measured using an intraoperative goniometer from an imageless navigation system. ER values across the three head lengths were compared using a repeated-measures analysis of variance and paired t-tests. Results Varying femoral head lengths demonstrated a statically significant and reproducible effect on intraoperative ER range (analysis of variance; P < .001) in each patient. An increased femoral head length (mean 3.4 mm) significantly decreased (P < .001) ER range by 10.8 ± 3.3° while a shortened femoral head length (mean 3.5 mm) significantly increased (P < .001) the ER ROM by 6.0 ± 3.8°. Conclusions The results of this study demonstrate the sensitivity of hip ROM to incremental changes in femoral head length. As ER is important for activities of daily living, inadvertent lengthening should be avoided.
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Haidamous G, Cabarcas B, Ohanisian L, Simon P, Christmas KN, Wilder L, Achors K, Mighell MA, Frankle MA. Does improved external rotation following reverse shoulder arthroplasty impact clinical outcomes in patients with rotator cuff pathology and external rotation less than 0°? J Shoulder Elbow Surg 2023; 32:68-75. [PMID: 35931335 DOI: 10.1016/j.jse.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to (1) evaluate whether improved external rotation (ER) in patients with preoperative ER <0° impacts their clinical outcomes following reverse shoulder arthroplasty (RSA) for rotator cuff (RC) pathology and (2) describe the differences in preoperative factors and postoperative outcomes in this patient population. Our hypothesis was that clinical outcomes would not be affected by improvement in ER using a lateralized glenosphere design. METHODS We retrospectively reviewed 55 patients with preoperative ER <0° who underwent primary RSA for RC pathology with lateralized glenosphere. Pre- and postoperative physician-reported ER was blindly measured using a videographic review of patients externally rotating their arm at the side. Patients were evaluated using 5 different patient-reported outcome score thresholds, measured at 12 months postoperatively: (1) minimal clinically important difference (MCID) for American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (ie, ≥20-point increase); (2) MCID for Simple Shoulder Test (SST) scores (≥2.4-point increase); (3) visual analog scale (VAS) for pain score >0; (4) mean ASES score (≥75); and (5) mean SST score (≥6.8), each of which was used to stratify the patients into 2 groups-greater than or equal to vs. less than the threshold. This resulted in 5 different evaluations comparing the 2 groups for any difference in postoperative ER or preoperative factors, including Hamada and Goutallier scores. RESULTS Regardless of the measured outcome, there was no difference in either postoperative physician- or patient-reported ER between patients who achieved scores higher or lower than the thresholds. Both Hamada and Goutallier score distributions were not different between groups across all the evaluated outcomes. Patients who achieved the MCID for ASES had worse preoperative VAS pain (7 vs. 4, P = .011) and SST (1 vs. 3, P = .020) scores. Across all outcome thresholds, except MCID for SST, pain reduction (ΔVAS) was significantly more pronounced in patients exceeding the thresholds. Improved forward flexion rather than ER was observed in those who achieved the ASES (160° vs. 80°, P = .020) and SST MCIDs (150° vs. 90°, P = .037). Finally, patients who exceeded the thresholds experienced higher satisfaction rates. CONCLUSION Improvement in ER does not appear to impact patient-reported outcome measures, including ASES and SST in patients with preoperative ER <0° undergoing RSA with a lateralized glenosphere. Patients with more severe pain and worse function at baseline experience less postoperative pain and clinically significant improvement in their reported outcomes.
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Affiliation(s)
- Georges Haidamous
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Brandon Cabarcas
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Levonti Ohanisian
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Kaitlyn N Christmas
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Lauren Wilder
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Kyle Achors
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Mighell
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Mark A Frankle
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA.
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Kazum E, Martinez-Catalan N, Caruso G, Schofield BA, Nidtahar I, Zampeli F, Valenti P. Reverse shoulder arthroplasty with isolated latissimus dorsi or combined with teres major transfer for lack of external rotation: a comparative study. Int Orthop 2022; 46:2273-2281. [PMID: 35922519 DOI: 10.1007/s00264-022-05530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) associated with two techniques: L'Episcopo procedure (combined teres major and latissimus dorsi transfer) and modified L'Episcopo procedure (isolated latissimus dorsi transfer). METHODS A retrospective review of 36 RSAs (mean age 69.8 years; SD 8.9) associated with either L'Episcopo procedure (Group 1, 21 cases) or modified L'Episcopo procedure (Group 2, 15 cases) was performed between 2007 and 2020. Clinical outcome measures consisted of range of motion (ROM), SSV, VAS, and Constant-Murley scores. These scores were compared between the two groups. Radiographs were assessed for transfer site bony lesions. RESULTS With a mean follow-up of 40.8 months (6-98; SD 28.8), no significant differences were revealed in the clinical outcomes: Constant score, SSV, VAS, ROM. The entire study group demonstrated a significant improvement in post-operative functional outcome scores and ROM parameters compared to their pre-operative state, IR measures being the only exception (p = 0.26). Radiographs demonstrated transfer site bony lesions in 60% of the patients (18/30). Three complications (8.3%) were noted in the study. CONCLUSION At the short-term follow-up, RSA combined with either latissimus dorsi (LD) transfer in isolation or in association with teres major proved to be equally effective in restoring external rotation in the settings of an irreparable postero-superior cuff tear treated with RSA. Although the LD transfer group displayed a tendency towards superior ROM, this was not supported statistically. Post-operative radiographs confirmed the presence of bony lesions at the transfer fixation sites in both groups of patients (52% vs. 72%).
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Affiliation(s)
- Efi Kazum
- Tel Aviv Sourasky Medical Center, Division of Orthopaedic Surgery, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
| | | | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris, 247/255, 10134, Turin, Italy
| | | | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
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Fleisig GS, Slowik JS, Daggett M, Rothermich MA, Cain EL, Wilk KE. Active range of motion of the shoulder: a cross-sectional study of 6635 subjects. JSES Int 2022; 7:132-137. [PMID: 36820423 PMCID: PMC9937824 DOI: 10.1016/j.jseint.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Normative data for passive range of motion are well established, but daily living is comprised of active motion. The purpose of this study was to establish normative values for active range of motion of the shoulder across age, sex, and arm. Our hypotheses were that active range of motion of the shoulder (1) decreases with age group, (2) differs between males and females, and (3) differs between the right arm and left arm. Methods Shoulder active range of motion was captured with an eight-camera markerless motion capture system. Data were collected for a heterogenous sample of 6635 males and females of all ages. For each subject, 6 shoulder motions were collected with maximum values measured: external rotation, internal rotation, flexion, extension, abduction, and horizontal abduction. Three-way repeated measures analyses were performed, with 2 between-subject factors (age group and sex) and 1 within-subject factor (arm). The unadjusted threshold for statistical significance was α = 0.05. Results External rotation decreased with age (approximately 10° decrease from below 30 years to above 60 years). External rotation was approximately 5° greater in the right arm, whereas internal rotation was approximately 5° greater in the left arm. Flexion decreased with age (approximately 15° decrease from below 20 years to above 60 years). For age groups from 10 to 59 years, extension and horizontal abduction were approximately 5° to 10° greater in females than males. Abduction was greater for females than males. Abduction was also greater in younger people (aged 10-29 years) than older people. Conclusion In general, active range of motion of the shoulder decreases with age. Sex (male/female) and arm side (right/left) also influence shoulder range of motion.
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Affiliation(s)
- Glenn S. Fleisig
- American Sports Medicine Institute, Birmingham, AL, USA,Corresponding author: Glenn S. Fleisig, PhD, American Sports Medicine Institute, 833 St. Vincent’s Drive, Suite 205, Birmingham, AL 35205, USA.
| | | | | | - Marcus A. Rothermich
- American Sports Medicine Institute, Birmingham, AL, USA,Andrews Sports Medicine & Orthopaedic Center, Birmingham, AL, USA
| | - E. Lyle Cain
- American Sports Medicine Institute, Birmingham, AL, USA,Andrews Sports Medicine & Orthopaedic Center, Birmingham, AL, USA
| | - Kevin E. Wilk
- American Sports Medicine Institute, Birmingham, AL, USA,Champion Sports Medicine, Birmingham, AL, USA
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Valenti P, Zampeli F, Caruso G, Nidtahar I, Martinez-Catalan N, Kazum E. Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome. Orthop Traumatol Surg Res 2022; 108:103263. [PMID: 35248792 DOI: 10.1016/j.otsr.2022.103263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RSA) associated with modified L'Episcopo (isolated LD) or L'Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. MATERIAL AND METHODS A retrospective review of 24 RSAs (mean age 68.71 years, range 52-83) associated with modified L'Episcopo procedure (9) and L'Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. RESULTS With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). CONCLUSION At short-term follow-up, RSA combined with L'Episcopo or modified l'Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\TM tendon transfer. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Frantzeska Zampeli
- Hand-Upper Limb-Microsurgery Department, General Hospital KAT, Athens, Greece
| | - Giovanni Caruso
- Shoulder Unit, Koelliker Hospital, Corso Galileo Ferraris 247/255, 10134 Turin, Italy
| | - Imen Nidtahar
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France
| | - Natalia Martinez-Catalan
- Paris Shoulder Unit, Clinique Bizet, 22, rue Georges-Bizet, 75116 Paris, France; Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv, Israel.
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Valenti P. Surgical procedure to restore shoulder external rotation in post-traumatic brachial plexus lesions in adults. Hand Surg Rehabil 2021; 41S:S39-S43. [PMID: 34407484 DOI: 10.1016/j.hansur.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 10/20/2022]
Abstract
The lack of active external rotation following a brachial plexus injury in adults is very disabling and very challenging to solve. If direct nerve surgery or nerve transfer fails or if the patient is seen too late, palliative surgery is the last resort. Shoulder fusion can stabilize the joint to increase strength at the elbow, but the patient loses all external rotation. A metaphyseal humeral osteotomy shifts the sector of mobility to push out the arm from the chest but does not restore any active external rotation. Latissimus dorsi and teres major transfers are not indicated in traumatic brachial plexus injuries. Lower trapezius (inferior fibers of the trapezius) transfer detached from the medial angle of the scapula and fixed to the infraspinatus tendon is the main option in paralyzed shoulders. It can restore 90° external rotation on average. This tendon transfer is an agonist, with the same direction but with less excursion and strength. If this muscle is paralyzed (nerve lesion), one can harvest and transfer the contralateral lower trapezius instead. The goals of this paper are to describe the surgical technique for these two tendons transfer, their indications and results.
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Affiliation(s)
- P Valenti
- Institut de la Main, Paris Shoulder Unit, Clinique Bizet, 23, Rue Georges Bizet, 75116 Paris, France.
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13
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Bonnevialle N, Elia F, Thomas J, Martinel V, Mansat P. Osteolysis at the insertion of L'Episcopo tendon transfer: Incidence and clinical impact. Orthop Traumatol Surg Res 2021; 107:102917. [PMID: 33813102 DOI: 10.1016/j.otsr.2021.102917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION During a L'Episcopo transfer procedure, the tendons of the latissimus dorsi and teres major are reinserted on the posterolateral side of the humeral shaft to restore active external rotation. The aim of this study was to monitor the radiological changes at the insertion point of this transfer and to evaluate its impact on the clinical outcomes. MATERIALS AND METHODS In this retrospective, single-center study, 13 patients (mean age 56 years; 19-84) were reviewed after a minimum follow-up of 2 years. The L'Episcopo transfer was done either alone (n=2) or in combination with reverse shoulder arthroplasty (n=11). The same transfer technique was used in both instances, with reattachment by transosseous sutures. The clinical assessment consisted of the Constant score (CS), the Activities of Daily Living Requiring Active External Rotation (ADLER) score and the Subjective Shoulder Value (SSV). Radiographs were used to look for signs of osteolysis of the cortical bone in the tendon transfer areas and classified as grade 1 (minor erosion), grade 2 (moderate erosion) and grade 3 (major erosion). RESULTS At a mean follow-up of 37 months (24-72), the mean CS was 60 points (32-75), the ADLER was 21 points (15-30) and the SSV was 77% (10-95). In the radiographic analysis, 10/13 patients had osteolysis visible in the transfer area: 2 were grade 1 (15%), 1 was grade 2 (8%), 7 were grade 3 (54%). There was no statistical correlation between the presence of osteolysis and the clinical outcomes. Nevertheless, external rotation with elbow at side and forward flexion were better in the patients who had osteolysis≥grade 2. CONCLUSION The L'Episcopo transfer is associated with frequent osteolysis of the humeral cortex where the transfer is attached, even though the transfer appears effective. Long-term follow-up will be needed to evaluate the impact of this osteolysis on the stability of any shoulder arthroplasty implants. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Nicolas Bonnevialle
- CHU Purpan, Hôpital Pierre Paul Riquet, Place du Dr Baylac, 31059 Toulouse, France; Institut de Recherche Riquet (I2R), Balma, France.
| | - Fanny Elia
- CHU Purpan, Hôpital Pierre Paul Riquet, Place du Dr Baylac, 31059 Toulouse, France
| | - Jonathan Thomas
- CHU Nice, Hôpital Pasteur 2, 30 voie Romaine, 06000 Nice, France
| | | | - Pierre Mansat
- CHU Purpan, Hôpital Pierre Paul Riquet, Place du Dr Baylac, 31059 Toulouse, France; Institut de Recherche Riquet (I2R), Balma, France
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Valenti P, Zanjani LO, Schoch BS, Kazum E, Werthel JD. Mid- to long-term outcomes after reverse shoulder arthroplasty with latissimus dorsi and teres major transfer for irreparable posterosuperior rotator cuff tears. Int Orthop 2021; 45:1263-1271. [PMID: 33517474 DOI: 10.1007/s00264-021-04948-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
AIM The objective of this study was to describe the outcome of reverse shoulder arthroplasty (RSA) combined with modified L'Episcopo procedure at long-term follow-up (5 to 12 years). METHODS A retrospective review of 17 RSAs (mean age 67.2 years) with the modified L'Episcopo procedure conducted between 2006 and 2016 was performed. All patients had a combined loss of active elevation and external rotation with an irreparable posterosuperior rotator cuff tear. Clinical assessment was performed with a minimum follow-up of five years (mean 97.3 months). Outcome measures included range of motion, subjective shoulder value (SSV), visual analogue scale (VAS), and Constant-Murley scores. RESULTS All patients (16) demonstrated a significant improvement in all clinical and functional parameters. VAS pain scores improved from 6 ± 2.6 to 1 ± 1; SSV improved from 35 ± 14 to 72 ± 10; active forward elevation increased from 66° ± 34 to 125° ± 29; and active external rotation arm at the body increased from -11° ± 22 to 21° ±11 and in 90° of abduction from -10° ± 17 to 37° ± 24. The mean Constant score improved from 25 ± 11 to 59 ± 8. Active internal rotation did not significantly change (p = 0.332). CONCLUSION At long-term follow-up, RSA combined with modified L'Episcopo procedure resulted in significant improvements in pain, range of motion, and functional scores for patients with shoulder pseudoparalysis and a lack of active external rotation caused by a massive posterosuperior cuff tear with a teres minor deficiency.
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Affiliation(s)
- Philippe Valenti
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France
| | - Leila Oryadi Zanjani
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France.,Shariati Hospital, District 6, Tehran, Tehran Province, 1313514117, Iran
| | | | - Efi Kazum
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France. .,Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center, Weizmann St 6, 6423906, Tel Aviv, Israel.
| | - Jean David Werthel
- Paris Shoulder Unit, Clinique Bizet, 22 rue Georges Bizet, 75116, Paris, France.,Hopital Ambroise Pare, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
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15
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Farmer KW, Higa M, Banks SA, Chang CC, Struk AM, Wright TW. Intraoperative measurements of reverse total shoulder arthroplasty contact forces. J Exp Orthop 2020; 7:98. [PMID: 33289882 PMCID: PMC7724012 DOI: 10.1186/s40634-020-00311-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Instability and fractures may result from tensioning errors during reverse total shoulder arthroplasty (RTSA). To help understand tension, we measured intraoperative glenohumeral contact forces (GHCF) during RTSA. Methods Twenty-six patients underwent RTSA, and a strain gauge was attached to a baseplate, along with a trial glenosphere. GHCF were measured in passive neutral, flexion, abduction, scaption, and external rotation (ER). Five patients were excluded due to wire issues. The average age was 70 (range, 54–84), the average height was 169.5 cm (range, 154.9–182.9), and the average weight was 82.7 kg (range, 45.4–129.3). There were 11 females and 10 males, and thirteen 42 mm and 8 38 mm glenospheres. Results The mean GHCF values were 135 N at neutral, 123 N at ER, 165 N in flexion, 110 N in scaption, and 205 N in abduction. The mean force at terminal abduction is significantly greater than at terminal ER and scaption (p < 0.05). Conclusions These findings could help reduce inappropriate tensioning.
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Affiliation(s)
- Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, 3rd Floor, Gainesville, FL, 32608, USA.
| | | | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, MAE-A 318, Gainesville, FL, 32611-6250, USA
| | - Chih-Chiang Chang
- Department of Mechanical & Aerospace Engineering, University of Florida, MAE-A 318, Gainesville, FL, 32611-6250, USA
| | - Aimee M Struk
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, 3rd Floor, Gainesville, FL, 32608, USA
| | - Thomas W Wright
- Orthopaedics and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
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Parsons M, Routman HD, Roche CP, Friedman RJ. Preoperative external rotation deficit does not predict poor outcomes or lack of improvement after reverse total shoulder arthroplasty. J Orthop 2020; 21:379-383. [PMID: 32921945 DOI: 10.1016/j.jor.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The purpose was to compare postoperative outcomes and functional improvement between patients with preoperative aER deficits vs. preserved aER function. RESULTS There were 115 patients in the <0° aER group and 314 in the ≥30° aER group. Preoperative patients in the <0° group were worse for all measures except subjective pain while post-operatively, they had significantly greater improvement for all measures of motion. Postoperatively, both groups achieved comparable scores for forward elevation, pain, SST and ASES. CONCLUSION This study demonstrates that patients with a complete aER deficit can recover substantial and comparable function after RTSA.
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Affiliation(s)
- Moby Parsons
- The Knee, Hip and Shoulder Center, Portsmouth, NH, USA
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Lafosse T, Gerosa T, Serane J, Bouyer M, Masmejean EH, Le Hanneur M. Double-Nerve Transfer to the Axillary Nerve in Traumatic Upper Trunk Brachial Plexus Injuries Using an Axillary Approach: Anatomical Description and Preliminary Case Series. Oper Neurosurg (Hagerstown) 2020; 19:E131-E139. [PMID: 31980828 DOI: 10.1093/ons/opz430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Restoration of shoulder external rotation remains challenging in patients with C5/C6 brachial plexus injuries (BPI). OBJECTIVE To describe a double-nerve transfer to the axillary nerve (AN), targeting both its anterior and posterior motor branches, through an axillary route. METHODS A total of 10 fresh-frozen cadaveric brachial plexuses were dissected. Using an axillary approach, the infraclavicular brachial plexus terminal branches were exposed, including the axillary, ulnar, and radial nerves. Under microscopic magnification, the triceps long head motor branch (TLHMB), anteromedial fascicles of the ulnar nerve (UF), the anterior motor branch of the axillary nerve (AAMB), and the teres minor motor branch (TMMB) were dissected and transected to simulate 2 nerve transfers, THLMB-AAMB and UF-TMMB. Several anatomical criteria were assessed, including the overlaps between fascicles when placed side-by-side. Six patients with C5/C6 BPI were then operated on using this technique. RESULTS TLHMB-AAMB and UF-TMMB transfers could be simulated in all specimens, with mean overlaps of 37.1 mm and 6.5 mm, respectively. After a mean follow-up of 23 mo, all patients had recovered grade-3 strength or more in the deltoid and teres minor muscles. Mean active shoulder flexion, abduction, and external rotation with the arm 90° abducted were of 128°, 117°, and 51°, respectively. No postoperative motor deficit was found in the UF territory. CONCLUSION A double-nerve transfer, based on radial and ulnar fascicles, appears to be an adequate option to reanimate both motor branches of the AN, providing satisfactory shoulder active elevations and external rotation in C5/C6 BPI patients.
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Affiliation(s)
- Thibault Lafosse
- Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France.,Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Thibault Gerosa
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Julien Serane
- Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France.,Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Michael Bouyer
- Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France
| | - Emmanuel H Masmejean
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Malo Le Hanneur
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
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Abstract
Background Some reverse total shoulder arthroplasty (rTSA) patients may have limited preoperative external rotation (ER) because of stiffness or weakness. Currently it is not known if this affects their clinical outcome or if their ER will improve after surgery. Methods A multicenter shoulder arthroplasty database was queried to analyze patients undergoing a primary rTSA using a single prosthesis design featuring a medial glenoid–lateral humerus. Their pre- and postoperative range of motion was evaluated in addition to 5 outcome measures. Patients with limited preoperative ER due to weakness or stiffness were compared to patients with normal preoperative range of motion. The following questions were asked: (1) Does a preoperative ER deficit impact the postoperative outcome? (2) Do patients with preoperative ER deficits due to stiffness or weakness regain ER after rTSA? and (3) Does a preoperative ER lag sign predict a poor outcome? Results 608 patients were included in this study. Active external rotation (preoperative/postoperative) was as follows for the 3 patient groups: Normal patients (45°/44°), Stiff (–4°/30°), and Weak (16°/32°). Weak patients had a preoperative ER lag of 30°, which improved by 16° after surgery. The clinical outcome scores for all 3 groups improved after rTSA. Stiff patients had significantly greater improvement than Weak and Normal patients. Outcome scores were equivalent for Normal and Stiff patients. Weak patients tended to have slightly lower outcome scores. Conclusions Patients with limited preoperative ER can obtain a good clinical result with rTSA using a medial glenoid–lateral humerus prosthesis, ER range of motion can improve after rTSA, and stiff patients have a particularly good prognosis for recovery.
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Murray JC, Leclerc A, Balatri A, Pelet S. Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial. Orthop Traumatol Surg Res 2020; 106:217-222. [PMID: 30502026 DOI: 10.1016/j.otsr.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients that sustain anterior shoulder dislocation frequently experience recurrence. Immobilisation in external rotation has been proposed as a treatment that could lower this risk. HYPOTHESIS There is a difference in recurrence rates between immobilization in internal or external rotation following a first-time anterior shoulder dislocation. PATIENTS AND METHODS Single-center randomized controlled trial. Fifty patients with a first episode of traumatic anterior dislocation were randomly assigned to immobilization in internal rotation (IR; 25 patients) or external rotation (ER; 25 patients) for three weeks. Clinical follow-up: 24 months. Additionally, some patients underwent a magnetic resonance imaging with intra-articular contrast (MR arthrography) within seven days after trauma, and then at three months. PRIMARY OUTCOME recurrence of dislocation. Secondary outcome: healing rate of labral lesions on MR arthrography. RESULTS Follow-up rate in the IR and ER group was 92% and 96% respectively. Recurrence rate did not show a statistically significant difference overall (IR 47.8% vs. ER 29.2%; p=0.188), but showed a significant difference favouring ER in the 20-40 years subgroup (IR 50% vs. ER 6.4%; p=0.044). Labral lesions' healing rate was 46.2% vs. 60% (IR vs ER; p=0.680). The recurrence rate among those with healed vs. non-healed labrum (regardless of immobilization) was 11.1% vs. 77.7% (p=0.001). DISCUSSION This study suggests that immobilization in ER compared to IR reduces the risk of recurrence after a first-time anterior shoulder dislocation in patients aged between 20 and 40 years. LEVEL OF EVIDENCE II, low-powered prospective randomized trial.
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Affiliation(s)
- Jean-Christophe Murray
- Department of orthopaedic surgery, CHU de Québec, hôpital Enfant-Jésus, 1401, 18(e) rue, G1J 1Z4 Québec, Canada
| | - Alexandre Leclerc
- Department of orthopaedic surgery, CHU de Québec, CHUL, 2705, boulevard Laurier, G1V 4G2 Québec, Canada
| | - Amerigo Balatri
- Department of orthopaedic surgery, CHU de Québec, hôpital Enfant-Jésus, 1401, 18(e) rue, G1J 1Z4 Québec, Canada
| | - Stéphane Pelet
- Department of orthopaedic surgery, CHU de Québec, hôpital Enfant-Jésus, 1401, 18(e) rue, G1J 1Z4 Québec, Canada; Centre de recherche FRQS du CHU de Québec, hôpital Enfant-Jésus, 1401, 18(e) rue, G1J 1Z4 Québec, Canada.
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Inui H, Nobuhara K. Modified Putti-Platt procedure for recurrent anterior shoulder instability. Int Orthop 2020; 44:1123-9. [PMID: 32055972 DOI: 10.1007/s00264-020-04509-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The classic Putti-Platt technique was modified by suturing the lateral subscapularis tendon to the capsule instead of the anterior glenoid edge. We report the clinical results of a modified Putti-Platt procedure in patients with traumatic anterior shoulder instability. METHODS The study reports results in 434 patients (450 shoulders) with traumatic anterior shoulder instability. The patients comprised 322 men and 122 women with a mean age of 22 years. Clinical results were evaluated by the Rowe score, Japan Shoulder Society Shoulder Instability Score (JSS-SIS); recurrence of instability, instability severity index score (ISIS), restriction of external rotation, return to sports activities, and osteoarthritis on plain radiographs and MRI were examined. RESULTS The mean Rowe score improved from 26 to 90 points, and the mean JSS-SIS improved from 51 to 88 points. Altogether, 419 patients (97%) had no recurrence at a minimum of two years of follow-up, even though the study included 87 patients with an ISIS of ≥ 7 points. External rotation was limited at 6 months, and 33 of 228 patients (14%) could not return to the same level of sports activities. Among 44 patients at the follow-up extending to ten to 27 years, external rotation was still limited but no plain radiography showed osteoarthritis more than stage 2. CONCLUSION This modified Putti-Platt procedure was not appropriate for throwing athletes but could be a surgical option for patients with high risk of recurrence.
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21
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Shimizu M, Kobayashi T, Chiba H, Jimbo S, Senoh I, Ito H. Adult spinal deformity and its relationship with hip range of motion: a cohort study of community-dwelling females. Spine J 2019; 19:1202-9. [PMID: 30769092 DOI: 10.1016/j.spinee.2019.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity affects lower extremity alignment with compensation in joint range of motion (ROM) and alignment of the hip. PURPOSE To investigate the relationship between sagittal spinopelvic alignment and the ROM of the hip joint and the femoral oblique angle (FOA). STUDY DESIGN Cross-sectional, observational cohort study of community-dwelling Japanese women. METHODS The study group included 158 women, enrolled in our ongoing prospective cohort study, with upright spine radiographs and physical measurements obtained for all participants. Radiographic spinopelvic parameters included measurement of thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope, pelvic incidence, and pelvic tilt (PT). FOA parameters were measured on hip radiographs and hip ROM included external and internal rotation and extension. The association between spinopelvic parameters, the FOA, and hip joint ROM was evaluated using Spearman's correlation analysis. RESULTS External rotation of the hip was correlated with LL (R=0.179, p=.024), PT (R=-0.273, p=.001) and SVA (R=-0.215, p=.007), with the FOA being correlated with the SVA (R=0.502, p<.001). CONCLUSIONS The decrease in hip external rotation with adult spinal deformity might reflect a structural modification in spinopelvic alignment. An increase in FOA was associated with an increase in SVA, indicative of a sagittal malalignment in the decompensated phase of adult spinal deformity.
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Wada O, Gamada K, Aoyama N, Mizuno K, Iwasaki Y. A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts. Clin Biomech (Bristol, Avon) 2019; 65:45-50. [PMID: 30965227 DOI: 10.1016/j.clinbiomech.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft. METHODS Ten patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control. FINDINGS The BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022). INTERPRETATION ACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kazuyoshi Gamada
- Department of Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima City, Hiroshima, Japan.
| | - Naoki Aoyama
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Yasunobu Iwasaki
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Aibinder WR, Elhassan BT. Lower trapezius transfer with Achilles tendon augmentation: indication and clinical results. Obere Extrem 2018; 13:269-272. [PMID: 30546491 PMCID: PMC6267384 DOI: 10.1007/s11678-018-0489-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/06/2018] [Indexed: 11/05/2022]
Abstract
Lower trapezius tendon transfer with Achilles tendon allograft augmentation may be used to treat patients with lack of active external rotation following shoulder paralysis or massive irreparable posterosuperior rotator cuff tears. In the setting of shoulder paralysis, the integrity of the ipsilateral lower trapezius may be compromised. In this instance, the contralateral lower trapezius may be used with reasonable results. In the setting of irreparable rotator cuff tears, the procedure may be performed through an open or arthroscopically assisted technique. The latter avoids the need for an acromial osteotomy and risk of nonunion associated with repair of the osteotomy. Both are effective in reversing pseudoparesis or pseudoparalysis. Advanced degenerative changes have an effect on outcomes, resulting in less pain improvement, decreased range of motion, and greater need for reoperation with conversion to reverse total shoulder arthroplasty. Nonetheless, the lower trapezius tendon transfer is an effective option for restoring active external rotation with relatively consistent results.
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Affiliation(s)
- William R Aibinder
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, 55905 Rochester, MN USA
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, 55905 Rochester, MN USA
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Jeon IC. Correlation between the distance of scapular anterior tilting and the ratio of internal and external rotation angle of shoulder in supine position. J Phys Ther Sci 2018; 30:1329-1330. [PMID: 30349173 PMCID: PMC6181657 DOI: 10.1589/jpts.30.1329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the relationship between the amount of scapular anterior tilting and the ratio of internal and external rotation of the shoulder in a supine position. [Participants and Methods] Twenty healthy participants (8 females, 12 males) were enrolled in this study. Internal rotation (IR) and external rotation (ER) of the glenohumeral joint were performed in a supine position, and the IR and ER angles were measured using a universal goniometer. The changing distance of scapular anterior tilting was measured by a three-dimensional motion analysis tracking system while participants performed IR and ER in a supine position. Pearson’s correlation coefficient was used to investigate the relationship between the distance of scapular anterior tilting and the ratio of internal and external rotation angle of the shoulder. [Results] The correlation of the degree of scapular anterior tilting with the IR/ER ratio, particularly the IR angle of the shoulder in a supine position, was good to excellent (r=−0.851). [Conclusion] The findings suggest that asymmetry of the IR and ER angles may cause increased scapular anterior tilting in a supine position.
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Affiliation(s)
- In-Cheol Jeon
- Department of Physical Therapy, Hoseo University: 20 Hoseo-ro, 79 beon gil, Baebang eup, Asan-si, Chungcheongnam-do 34199, Republic of Korea
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Yamamoto N, Kawakami J, Nagamoto H, Shiota Y, Itoi E. The relationship between the glenoid track and the range of shoulder motion: A cadaver study. Orthop Traumatol Surg Res 2018; 104:793-796. [PMID: 29292122 DOI: 10.1016/j.otsr.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The concept of the glenoid track has been proposed to evaluate the risk of dislocation. The glenoid track width was demonstrated to be 84% of the glenoid width in cadaveric shoulders and 83% in live shoulders. HYPOTHESIS The glenoid track width seems to be affected by the range of motion. PURPOSE The purpose of this study was to determine the relationship between the glenoid track and the range of shoulder motion. METHODS Ten fresh-frozen cadaveric shoulders were used. The specimen was fixed to a shoulder-positioning device. The anterior rim of the glenoid was marked on the humeral head using a Kirschner wire with the arm in 60° of abduction. This marking was repeated with the arm in (1) horizontal flexion/extension and (2) internal/external rotations (0° to max). The distances from the Kirschner wire markings to the footprint of the rotator cuff tendon were measured. RESULTS The greater the angle of the horizontal extension or external rotation, the smaller the glenoid track width, whereas the greater the angle of the horizontal flexion or internal rotation, the greater the glenoid track width. There was a negative relationship between them. The horizontal flexion/extension motion was demonstrated to affect the glenoid track width more than the internal/external rotation motion. CONCLUSION The glenoid track width decreased with the increase of horizontal extension. We should consider the range of horizontal extension angle when applying the glenoid track concept in clinical practice. TYPE OF STUDY Laboratory study.
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Affiliation(s)
- N Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - J Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - H Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Y Shiota
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - E Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Wight JT, Grover GB, Chow JW, Borsa PA, Wikstrom EA, Tillman MD. Developing reliable measures of the passive torque-angle relationship for shoulder internal and external rotation: Implications for overhead athletics. Phys Ther Sport 2018; 33:82-88. [PMID: 30053716 DOI: 10.1016/j.ptsp.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES 1) Thoroughly assess shoulder flexibility by establishing the passive torque-angle relationship for internal and external rotation with the arm in an overhead athletics position (abducted 90°) and 2) test the reliability of four passive torque-angle measures. DESIGN Reliability study. SETTING Data were collected in a university biomechanics laboratory. PARTICIPANTS Bilateral shoulder flexibility of 15 male college students (20.7 ± 1.1 y) was evaluated twice in two sessions over 7-10 days. MAIN OUTCOME MEASURES For both ER and IR, reliability was assessed bilaterally (intra-session, inter-session, and inter-tester) for the traditional range of motion measure and three novel kinetic measures: torque at end ROM, resistance onset angle, rotational stiffness. This resulted in 48 total assessments. RESULTS Thirty-four assessments had good to excellent reliability (ICC ≥ 0.8), 10 had fair reliability (0.7 ≤ ICC < 0.8), and 4 had poor reliability (ICC< 0.7). Three of the four flexibility measures had a good overall ICC score: ROM (0.83), torque at end ROM (0.84), and resistance onset angle (0.81). The fourth, stiffness, had a fair overall reliability score (0.74). CONCLUSIONS The passive torque-angle measures should be assimilated into clinical and research settings to determine the relevance to injury, rehabilitation, and performance.
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Affiliation(s)
- Jeff T Wight
- Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, 2800 University Blvd North, Jacksonville, FL, 32211, USA.
| | - Guy B Grover
- Regeneration Technologies, Inc., 11621 Research Circle, Alachua, FL, 32615, USA.
| | - John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Jackson, MS, 39216, USA.
| | - Paul A Borsa
- Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Room 100, Gainesville, FL, 2611-8205, USA.
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 311 Woollen Gym, Chapel Hill, NC, 27599, USA.
| | - Mark D Tillman
- WellStar College of Health and Human Services, Kennesaw State University, 1000 Chastain Road, Kennesaw, GA, 30144, USA.
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Bonnin MP, Saffarini M, Nover L, van der Maas J, Haeberle C, Hannink G, Victor J. External rotation of the femoral component increases asymmetry of the posterior condyles. Bone Joint J 2017; 99-B:894-903. [PMID: 28663394 DOI: 10.1302/0301-620x.99b7.bjj-2016-0717.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/21/2017] [Indexed: 11/05/2022]
Abstract
AIMS The morphometry of the distal femur was largely studied to improve bone-implant fit in total knee arthroplasty (TKA), but little is known about the asymmetry of the posterior condyles. This study aimed to investigate the dimensions of the posterior condyles and the influence of externally rotating the femoral component on potential prosthetic overhang or under-coverage. PATIENTS AND METHODS We analysed the shape of 110 arthritic knees at the time of primary TKA using pre-operative CT scans. The height and width of each condyle were measured at the posterior femoral cut in neutral position, and in 3º and 5º of external rotation, using both central and medial referencing systems. We compared the morphological characteristics with those of 14 TKA models. RESULTS In the neutral position, the dimensions of the condyles were nearly equal. Externally rotating the femoral cut by 3º and 5º with 'central referencing' induced width asymmetry > 3 mm in 23 (21%) and 33 (30%) knees respectively, while with 'medial referencing' it induced width asymmetry > 3 mm in 43 (39%) and 75 (68%) knees respectively. The asymmetries induced by rotations were not associated with gender, aetiology or varus-valgus alignment. CONCLUSION External rotation may amplify the asymmetry between the medial and lateral condyles, and exacerbate prosthetic overhang, particularly in the superolateral zone. 'Central referencing' guides result in less potential prosthetic overhang than 'medial referencing' guides. Cite this article: Bone Joint J 2017;99-B:894-903.
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Affiliation(s)
- M P Bonnin
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - M Saffarini
- ReSurg SA, ch. De la Vuarpilliere 35, 1260 Nyon, Switzerland
| | - L Nover
- ReSurg SA, ch. De la Vuarpilliere 35, 1260 Nyon, Switzerland
| | - J van der Maas
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - C Haeberle
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - G Hannink
- Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - J Victor
- Ghent University, De Pintelaan, Ghent, Belgium
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Abstract
Restoration of shoulder function in patients with brachial plexus injury can be challenging. Initial reported efforts were focused on stabilizing the shoulder, improving inferior subluxation and restoring abduction and flexion of the joint. Recent advancements and improved understanding of coordinated shoulder motion and the biomechanical properties of the muscles around the shoulder applicable to tendon transfer have expanded available surgical options to improve shoulder function, specifically external rotation. Despite the advances in reconstructive options, brachial plexus injury remains a serious problem that requires complex surgical solutions, prolonged recovery, and acceptance of functional loss.
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Affiliation(s)
- Chelsea C Boe
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, College of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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29
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Jung MC, Kim SJ, Rhee JJ, Lee DH. Electromyographic activities of the subscapularis, supraspinatus and infraspinatus muscles during passive shoulder and active elbow exercises. Knee Surg Sports Traumatol Arthrosc 2016; 24:2238-43. [PMID: 25813676 DOI: 10.1007/s00167-015-3586-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Postoperative exercises may increase load on repaired tendons. Differences in the activity of the rotator cuff muscles were assessed during several different types of passive shoulder and active elbow exercises. METHODS In 15 healthy subjects, passive forward flexion of the shoulder was performed using a table, pulley and rope, and a cane, and external rotation was performed using a cane and a wall. The active elbow flexion-extension exercise was also performed while holding the upper arm with the contralateral hand. Activation amplitudes of the supraspinatus, infraspinatus and subscapularis muscles were evaluated using electromyography with fine wires. RESULTS During passive forward flexion, the supraspinatus and infraspinatus muscles exhibited lower activity when using a table compared with a cane (both P < 0.01) and a pulley and rope (both P < 0.05). Flexion of <90° decreased supraspinatus activation compared with 170° (P = 0.047). During external rotation of the shoulder while using the cane and wall, there was no difference in the activity of any muscles. Electromyographic activity during the active elbow exercise was lower in the supraspinatus while holding the upper arm (P = 0.018). CONCLUSION The table sliding exercise may reduce stress on the rotator cuff during passive forward flexion more than the other exercises do. Decreasing the range of motion to less than 90° in forward flexion activated the supraspinatus less. Moreover, movement of the elbow can be performed holding the upper arm to activate the rotator cuff to a lesser extent. LEVEL OF EVIDENCE Prognostic study, Level II.
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Affiliation(s)
- Myung-Chul Jung
- Department of Industrial Engineering, Ajou University, Suwon, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Yonsei University Health System, Yonsei University Arthroscopy and Joint Research Institute, Seoul, Korea
- Department of Orthopaedic Surgery, Graduated School of Medicine, Yonsei University, Seoul, Korea
| | - Jae-Jun Rhee
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, San 5, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Doo-Hyung Lee
- Department of Orthopaedic Surgery, Graduated School of Medicine, Yonsei University, Seoul, Korea.
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, San 5, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Korea.
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Mihata T, Takeda A, Kawakami T, Itami Y, Watanabe C, Doi M, Neo M. Isolated glenohumeral range of motion, excluding side-to-side difference in humeral retroversion, in asymptomatic high-school baseball players. Knee Surg Sports Traumatol Arthrosc 2016; 24:1911-7. [PMID: 25079133 DOI: 10.1007/s00167-014-3193-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/15/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE Glenohumeral range of motion is correlated with shoulder capsular condition and is thus considered to be predictive of shoulder pathology. However, in throwing athletes, a side-to-side difference in humeral retroversion makes it difficult to evaluate capsular condition on the basis of glenohumeral range of motion measured by using the conventional technique. The purpose of this study was to measure isolated glenohumeral rotation, excluding side-to-side differences in humeral retroversion, in asymptomatic high-school baseball players. METHODS A total of 195 high-school baseball players (52 pitchers and 143 position players; median age, 16 years) and 20 high-school non-throwing athletes (median age, 16 years) without any shoulder symptoms were enroled in this study. Glenohumeral external and internal rotations were measured by using both a conventional technique and our ultrasound-assisted technique. This technique, neutral rotation, was standardized on the basis of the ultrasonographically visualized location of the bicipital groove to exclude side-to-side differences in humeral retroversion from the calculated rotation angle. Intra- and inter-observer agreements of rotational measurements were evaluated by using intra-class correlation coefficients (ICCs). RESULTS Isolated glenohumeral rotation measurements, excluding side-to-side differences in humeral retroversion, demonstrated excellent intra-observer (ICC > 0.89) and inter-observer (ICC > 0.78) agreements. Isolated glenohumeral internal rotation was significantly less in the dominant shoulder than in the non-dominant shoulder in asymptomatic baseball players (P < 0.001). Isolated glenohumeral external rotation in baseball players was significantly greater than in non-throwing athletes (P < 0.05). In the baseball players, humeral torsion in the dominant shoulder was significantly greater than that in the non-dominant shoulder (P < 0.001), indicating that the retroversion angle was greater in dominant shoulders than in non-dominant shoulders. CONCLUSIONS Isolated glenohumeral external and internal rotations can be measured with high intra- and inter-observer reliability with the exclusion of side-to-side differences in humeral retroversion. Capsular and muscular changes in the throwing shoulder may be better evaluated by using our ultrasound-assisted technique. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. .,Daiichi Towakai Hospital, Takatsuki, Osaka, Japan. .,Katsuragi Hospital, Kishiwada, Osaka, Japan.
| | | | - Takeshi Kawakami
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Chisato Watanabe
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Salvador Comino MR, Krane S, Schelling J, Regife García V. [Differences and similarities of primary care in the German and Spanish health care systems]. Aten Primaria 2016; 48:131-5. [PMID: 26363955 PMCID: PMC6877819 DOI: 10.1016/j.aprim.2015.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 11/24/2022] Open
Abstract
An efficient primary care is of particular importance for any countries' health care system. Many differences exist on how distinctive countries try to obtain the goal of an efficient, cost-effective primary care for its population. In this article we conducted a selective literature review, which includes both scientific and socio-political publications. The findings are complemented with the experience of a Spanish physician from Seville in her last year of training in family medicine, who completed a four months long rotation in the German health care system. We highlighted different features by comparing both countries, including their health care expenditure, the relation between primary and secondary care, the organization in the academic field and the training of future primary care physicians. It is clear that primary care in both countries plays a central role, have to deal with shortcomings, and in some points one system can learn from the other.
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Affiliation(s)
| | - Sibylla Krane
- Medicina de Familia, Hospital Universitario Ludwig Maximilians, Múnich, Alemania
| | - Jörg Schelling
- Medicina de Familia, Hospital Universitario Ludwig Maximilians, Múnich, Alemania
| | - Víctor Regife García
- Medicina de Familia, Centro de Salud San Luís, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Wright T, Easley T, Bennett J, Struk A, Conrad B. Shoulder arthroplasty and its effect on strain in the subscapularis muscle. Clin Biomech (Bristol, Avon) 2015; 30:373-6. [PMID: 25740229 DOI: 10.1016/j.clinbiomech.2015.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 02/07/2015] [Accepted: 02/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increasing the thickness of the prosthetic humeral head on subscapularis strain in patients undergoing total shoulder arthroplasty has not been elucidated. The optimal postoperative rehabilitation for total shoulder arthroplasty that does not place excessive strain on the subscapularis is not known. We hypothesize that the use of expanded non-anatomic humeral heads during shoulder replacement will cause increased tension in the repaired subscapularis. We identified a recommended passive range of motion program without invoking an increase in tension in the repaired subscapularis, and determined the impact of the thickness of the humeral head on subscapularis strain. METHODS Eight fresh-frozen, forequarter cadaver specimens were obtained. An extended deltopectoral incision was performed and passive range-of-motion exercises with the following motions were evaluated: external rotation, abduction, flexion, and scaption. An optical motion analysis system measured strain in the subscapularis. The same protocol was repeated after performing a subscapularis osteotomy and after placement of an anatomic hemiarthroplasty of three different thicknesses. FINDINGS For abduction and forward flexion, we observed a trend of decreasing strain of the subscapularis, as the laxity is removed with increasing humeral head component thickness. With the short humeral head, strain was similar to native joint with passive scaption and flexion but not with external rotation or abduction. INTERPRETATION The passive range of motion that minimizes tension on the subscapularis is forward flexion and scaption. Therefore, passive forward flexion or scaption does not need to be limited, but external rotation should have passive limits and abduction should be avoided.
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Affiliation(s)
- Thomas Wright
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32611, USA.
| | - Thomas Easley
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32611, USA
| | - Jessica Bennett
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32611, USA
| | - Aimee Struk
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32611, USA
| | - Bryan Conrad
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32611, USA
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Momenzadeh OR, Pourmokhtari M, Sefidbakht S, Vosoughi AR. Does the position of shoulder immobilization after reduced anterior glenohumeral dislocation affect coaptation of a Bankart lesion? An arthrographic comparison. J Orthop Traumatol 2015; 16:317-21. [PMID: 25894458 DOI: 10.1007/s10195-015-0348-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 03/26/2015] [Indexed: 11/25/2022] Open
Abstract
Background The position of immobilization after anterior shoulder dislocation has been a controversial topic over the past decade. We compared the effect of post-reduction immobilization, whether external rotation or internal rotation, on coaptation of the torn labrum. Materials and methods Twenty patients aged <40 years with primary anterior shoulder dislocation without associated fractures were randomized to post-reduction external rotation immobilization (nine patients) or internal rotation (11 patients). After 3 weeks, magnetic resonance arthrography was performed. Displacement, separation, and opening angle parameters were assessed and analyzed. Results Separation (1.16 ± 1.11 vs 2.43 ± 1.17 mm), displacement (1.73 ± 1.64 vs 2.28 ± 1.36 mm), and opening angle (15.00 ± 15.84 vs 27.86 ± 14.74 °) in the externally rotated group were decreased in comparison to the internally rotated group. A statistically significant difference between groups was seen only for separation (p = 0.028); p values of displacement and opening angle were 0.354 and 0.099, respectively. Conclusion External rotation immobilization after reduction of primary anterior shoulder dislocation could result in a decrease in anterior capsule detachment and labral reduction. Level of evidence Level 2.
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Liu A, Xue X, Chen Y, Bi F, Yan S. The external rotation immobilisation does not reduce recurrence rates or improve quality of life after primary anterior shoulder dislocation: a systematic review and meta-analysis. Injury 2014; 45:1842-7. [PMID: 25150749 DOI: 10.1016/j.injury.2014.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Conducting a systematic review and meta-analysis of prospective randomised controlled trials directly comparing (1) the rates of recurrence and (2) patient-based quality-of-life assessments after the external rotation (ER) or internal rotation (IR) immobilisation after primary anterior shoulder dislocation. METHODS PubMed, EMBASE, the Cochrane Library and ISI Web of Science were searched up to January 2013, using the Boolean operators as follows: (bankart lesion OR shoulder anterior dislocation) AND ((external rotation AND internal rotation) OR immobilisation). All prospective randomised controlled trials directly comparing recurrence rate and patient-based quality-of-life assessments between the ER and IR immobilisations were retrieved. No limitation of the language or publication year existed in our analysis. RESULTS Seven of 896 studies involving 663 patients were included, 338 in the ER group and 325 in the IR group. No significant difference was observed in the recurrence rate at all ages (risk ratio (RR)=0.65; 95% confidence interval, 0.41-1.03; p=0.067), at the age stratum of ≤30 years (RR=0.70; 95% confidence interval, 0.38-1.29; p=0.250) and >30 years (RR=0.86; 95% confidence interval, 0.38-1.97; p=0.722). Four trials adopted quality-of-life assessments, using the Constant-Murlay functional scoring system, the Rowe scoring system, the Western Ontario Shoulder Instability index (WOSI), the Disabilities of arm, shoulder and hand (DASH) and the American Shoulder and Elbow Surgeons evaluation form (ASES). Only one trial demonstrated borderline statistical significance (p=0.05) and probable superiority of the ER group based on the ASES. No significant difference was observed in other three trials. CONCLUSION Based on the results of our analysis, the ER immobilisation could not reduce the rates of recurrence after primary anterior shoulder dislocation or improve the quality of life compared with the IR immobilisation. More rigorous and adequately powered prospective randomised controlled trials with long-term follow-ups are required to elucidate a more objective outcome.
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Affiliation(s)
- An Liu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009 Hangzhou, People's Republic of China
| | - Xinghe Xue
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009 Hangzhou, People's Republic of China
| | - Yunlin Chen
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009 Hangzhou, People's Republic of China
| | - Fanggang Bi
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009 Hangzhou, People's Republic of China
| | - Shigui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009 Hangzhou, People's Republic of China.
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Dessery Y, Belzile EL, Turmel S, Corbeil P. Comparison of three knee braces in the treatment of medial knee osteoarthritis. Knee 2014; 21:1107-14. [PMID: 25156178 DOI: 10.1016/j.knee.2014.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/07/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. METHODS Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. RESULTS Knee pain was alleviated with all three braces (p<0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw∗Ht (p<0.001) and 0.293 to 0.268 (p<0.05), respectively, while no significant reduction was observed with the V3P-brace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. CONCLUSIONS No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term.
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Affiliation(s)
- Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada
| | - Etienne L Belzile
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada.
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Abstract
This article presents a concise description and literature review of the eLibra Dynamic Ligament Balancing Device in total knee arthroplasty. This device is a force sensor that allows surgeons to balance the medial and lateral collateral ligaments during total knee replacement. This instrument provides precise, quantitative, digital information in newtons during surgery that allows surgeons to accurately externally rotate the femoral component in order to balance the forces across the medial and lateral compartments. The device is highly accurate and simple to use. It relies on objective dynamic data to balance the knee rather than static landmarks or subjective tensiometers.
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Affiliation(s)
- David A Camarata
- Ortho Arizona: Arizona Bone and Joint Specialists, 5620 East Bell Road, Scottsdale, AZ 85254, USA.
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Abstract
Restoration of shoulder external rotation in patients with paralytic shoulder is very challenging. When nerve repair and/or transfer fails, or if patients present late after injury such that nerve reconstruction is not possible, tendon transfer to restore shoulder external rotation becomes the main option. Good outcome has been reported with lower trapezius transfer to the infraspinatus to restore shoulder external rotation in patients with paralytic shoulder. The purpose of this manuscript is to describe the surgical technique of this transfer.
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García-Garrido AB, Caballero LG, Basiuk S. [Sharing experiences: rotation in primary care in Posadas, Argentina]. Semergen 2013; 39:309-12. [PMID: 23746704 DOI: 10.1016/j.semerg.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/20/2022]
Abstract
Primary care should be the cornerstone of any health system. It is the first contact with the community health system of any country. The Declaration of Alma-Ata, 1978, seeks to provide the basis for the construction of a new health system that will allow the full exercise of the right to health. Carrying out an external rotation in Primary Care in Posadas, Misiones Province, Argentina, during medical training, in family medicine, offers an insight into how other health systems work, provide health care to the community in a Primary Care Center in a country with its similarities and differences like ours, follow the implementation of programs, working with family medicine residents in another country, and living a rewarding personal and professional experience.
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